Menopause for Men?
by Brock Smith, RPh, BS PharmD and Paul Hueseman, Doctor of
brought to you by Bellevue Pharmacy, a ProjectAWARE
Most do not realize that men experience a change in their hormonal
production and balance that in many ways is very similar to menopause.
It is called andropause. In fact, andropause is often referred to
as "male menopause".
signs of andropause
- inability to concentrate
- mood swings
- loss of memory
- decreased energy
- loss of libido (sex drive)
- decreased erectile function
- decreased strength of orgasm
- decreased muscle mass
- increased fat
Andropause occurs when a man's production of hormones declines
to below normal levels. These hormones include testosterone, thyroid,
human growth hormone (HGH), and dihydroepiandosterone (DHEA). In
addition, production of estrogen actually increases in men undergoing
A man's testosterone level typically begins to fall by the time
he reaches his 50s, but for many men it may start to occur in his
early 30s. The diagnosis of andropause should include complete blood
count and chemistry profile, free and total testosterone, estradiol
(estrogen), progesterone, DHEA, luteinizing hormone and homocysteine.
When interpreting the results, the free testosterone in the serum
or blood should be in the mid- to high-normal range (10.8 nmol/L
to 24.6 nmol/L), and estradiol (estrogen) in the low-normal range
(below 32 pg/ml). A saliva test can also be used to measure testosterone,
DHEA, and estrogen levels, although the normal levels are different
than normal levels from serum that are provided above. Saliva tests
can be purchased from Bellevue Pharmacy Solutions with a prescription,
and the results can be interpreted by your physician along with
consultation by one of the hormone specialists on staff at Bellevue
The balance between the testosterone and estrogen is very important.
While some estrogen protects against osteoporosis by increasing
bone density and may decrease the risk for prostate cancer, mens
testosterone level should be greater than their estrogen level.
In many men over fifty, the estrogen level is greater than the testosterone
level, which is unacceptable.
The choices for supplementation of testosterone in males are quite
numerous at this time, but only a few are commercially available.
Patients and their physician have options to choose from that best
fit their needs which include: topical gels, creams, oral capsules,
and injectable forms. The other choices that can be made by a compounding
pharmacy may include a gel, cream, pellet, or sublingual tablet
that is custom made to your physician's order. The sublingual tablets
dissolve under the tongue and are absorbed by the blood vessels
in the oral mucosa thereby bypassing the step many drugs go through
in the livercalled "first pass metabolism"to
be broken down. Gels and creams are applied topically to the skin
and absorbed through the skin into the bloodstream. A less popular
but very effective way to administer testosterone is in a pellet
form. The pellet is placed under the skin with a local anesthetic
and a trochar device. The pellet dissolves in the subcutaneous layer
of the skin, providing a steady release of testosterone over eight
to twelve weeks. This procedure is generally done four to six times
A breakdown product of testosterone is dihydrotestosterone (DHT).
Increased levels of DHT may lead to hair loss. Bellevue Pharmacy
can compound combination of anastrozole and finasteride with a prescription.
This has been used in combination to lower the DHT and estrogen
levels. Oftentimes, this combination is taken in addition to a testosterone
supplement. Patients taking testosterone supplements should have
their testosterone and estrogen levels measured after four to six
weeks to determine if they are receiving the proper dose of medications.
In addition to testosterone products, other hormone supplements,
such as DHEA and human growth hormone (HGH), are available from
compounding pharmacies. In addition, a nutritional supplement, "Prostasixx",
can help lower estrogen levels and at the same time increase testosterone
The goal of therapy in treating andropause is hormone replacement
to achieve younger, healthier levels in order to reverse the signs
of andropause and the effects of aging. Treating andropause may
also have positive effects on blood pressure, diabetes, heart disease
For questions and further information about andropause,
treatments and Prostasixx, contact Bellevue